Provider Enrollment Management System

The vendor is required to provide provider enrollment management system for include:
• Utilize architectures with no single point of failure, supporting fault tolerance and failover of web, application, database, storage, and secondary devices.
• The following provider module environments: development, system integration testing, user acceptance testing and production, along with the capability to provision, populate, and configure additional environments as business needs arise.
• Production solution that will be available and accessible twenty-four (24) hours a day, seven (7) days a week, with the exception of planned downtime due to system upgrades or routine maintenance, and all planned downtime and maintenance outages will be coordinated and approved by state at least 48 business hours in advance.
• Solution that will identify the physical location(s) where the offeror's solution is installed and operating and ensure state has transparent access to this location(s).
• Business rules engine (BRE) solution shall allow authorized system users including state resources, the ability to create, configure and maintain rules for business functions in a user-friendly graphical user interface (GUI) that facilitates rules maintenance without coding changes by subject matter experts or technical resources to write natural language business rules (i.e. Human readable).
• Real time view and update access to a business rules catalog, in an electronic format approved by the state that documents all business rule logic used by the solution with an audit trail of business rules changes.
• Allow changes to be made to valid values without impacting production rules engine availability and operations.
• The ability to debug business rules at rule execution.
• Multiple users to work concurrently on different parts of the same rule base.
• Rollback to prior versions of rules without impacting production rules engine availability and operations.
• Maintain a graphical representation of business rule flow(s) and orchestration for all business rules.
• Mechanisms to identify which rules are executed for each specific business process.
• Produce a report on rules passed or failed for all transactions.
• Use standardized business rules definitions where applicable.
• Execute in a runtime environment.
• That tracks and has the capability to monitor licensure and certification information continually, including data exchanges with state if appropriate.
• Providers with license that have not been removed should be updated timely to prevent claims payment.
• Review with state, on an annual basis, the data stored within the provider module associated with lifetime procedures, transactions related to claims processing for lifetime procedures, legal matters, and lawsuits.
• Retain all Medicaid data identified as lifetime procedures, and transactions related to claims processing for lifetime procedures, as requested by state in a non-archived state until such time as state gives approval to archive or purge the specified data.